Selecting Implementing and Evaluating Environmental and PopulationBased Prevention

Selecting, Implementing, and Evaluating Environmental and Population-Based Prevention Strategies How To Use Science in Practice Harold D. Holder, Ph. D. Prevention Research Center Berkeley, California

Goals n Goal 1: Learn about population-based prevention approaches and “environmental strategies” n Goal 2: Learn what local prevention need to do in assessing, implementing, and evaluating environmental strategies, i. e. , strategic planning. n Goal 3: Learn how to evaluate environmental strategies

What are some popular beliefs about environmental prevention strategies? Environmental strategies are difficult to implement. Too costly. 2. Environmental strategies will not work in our community. 3. We are already doing environmental strategies. 4. ATOD abuse is more an individual problem and environmental strategies are not relevant. 5. Environmental strategies can not be evaluated. 6. Environmental strategies do not work with children and pre-teen youth. 1.

Biggest Current Mistakes in Prevention? n Doing many things that have little or no effect…. n “Not incorporating best prevention research into assessment, planning, and evaluation”

Current Challenges and Opportunities for Prevention n Public Requirement of Outcomes Recommendation: Develop outcome data to show results n Health Care Reform Recommendation: Take advantage of emphasis on prevention and outcomes in Health Care Reform documentation n State Budget Cutbacks Recommendation: Demonstrate cost-effectiveness

Just What Is Environmental Prevention, Anyway? n Environmental strategies in a community seek: 1. To bring about system-level change (including physical space, local community policies, availability of drugs and alcohol, etc. ) in order 2. To reduce substance abuse problems at the population level. That is Public Health. n Both conditions must be met.

Outcomes-Based Prevention Substancerelated consequences and substance use Intermediate variables Programs/ policies/ practices Implementing the Strategic Prevention Framework Planning, Monitoring, Evaluation, and Replanning

States are familiar with logic models: Tools for assessing, planning, implementing, and evaluating prevention.

Logic models are composed of: 1. Prevention goal, i. e. , specific ATOD outcome to be reduced or changed 2. Intermediate variables or factors, which need to be changed (or considered) in order to achieve the goal 3. Intervention strategies to change intermediate variables.

Example Logic Model for Substance Abuse Prevention What is wrong with this picture? Substance. Related Consequences Substance Use Underage and Young Adult Binge Drinking Alcohol. Related Traffic Crashes Among 15 - to 24 -Year-Olds Underage and Young Adult Driving After Drinking Youth 30 -Day Cannabis Use Intermediate Variables School Bonding for Youth School Drug Resistance Training Awareness of Risk of Drinking Low Personal Self-Esteem Strategies Number of DUI Arrests Highly Visible DUI Enforcement Increased Abstinence Public Education About Drinking and Driving Risks Family Training Youth and Young Adult Lifetime Drinking Perceived Risk of Drinking and Driving Enforcement Youth Frequent Exposure to Internet Responsible Beverage Service To Reduce Overserving

Alcohol Sales and Service Regulations, Enforcement, and Sanctions DUI Enforcement Alcohol-Related Motor Vehicle Crash Model Public Awareness of Drinking/Driving Enforcement Price Retail Availability Alcohol Serving and Sales Practices Perceived Risk of DUI Arrest Drinking Community Norms– Drinking Social Availability Community Norms– Drinking and Driving After Drinking Alcohol-Related Motor Vehicle Crashes Individual Factors Research Evidence Strong Relationship Moderate Relationship Drinking Context Minor Relationship Little Research Evidence but Logical Relationship

Review of Research Evidence for Logic Models WWW. PIRE. org Under “Featured Websites” to “Logic Models for the Prevention of Alcohol, Tobacco, and Other Drug Problems, ” select tab in right-hand column.

Underage Drinking Logic Model Retailer training & rewards Compliance checks, citations, license loss Retail sale of alcohol to youth Discount bans Price Underage drinking laws Visible enforcement Party patrol, shoulder taps, beer keg registration Local alcohol policy Media advocacy Social availability of alcohol to youth (parties, peers, families) Underage drinking Community concerns about youth drinking Legal risks for providing alcohol to underage youth

Examples of Effective Local Prevention Projects Utilizing Environmental Strategies

National Community Trial To Prevent Alcohol-Involved Trauma - Modesto Salinas Orange Oceanside . . . Florence Sumter Experimental Comparison

Alcohol-Involved Trauma at the Community Level: Logic Model````` MOBILIZATION Local News About Alcohol Problems and Enforcement DRINKING AND DRIVING Perceived Risk of Arrest Local Law Enforcement RESPONSIBLE BEVERAGE SERVICE Alcohol Serving and Sales Practices Social Access to Alcohol Driving After Drinking UNDERAGE DRINKING Local Regulation of Alcohol (density, hours of sale) Retail Alcohol Availability (on- and off-premise) ALCOHOL ACCESS Alcohol Intoxication or Impairment Alcohol-Involved Injury Non-Traffic Risk Activities

Restaurant Service

Highly visible and increased actual drinking and driving enforcement

Underage Drinking In Salinas California, 90% of students who drink report attending parties where minors drank.

Intermediate Variable and Strategy Data

Underage Alcohol Prevention Activities

“Mountain of Beer”

Underage Alcohol Purchase Survey Experimental and Comparison Communities 60 Percent Selling 50 PRETEST POSTTEST 53 40 47 45 35 30 20 19 10 16 0 Comparison Experimental No Training Experimental Training Holder, et al. , J. American Medical Association, 2000

Outcomes What were final results?

Examples of Community Action Projects for Environmental Prevention COUNTRY GOALS STRATEGIES RESULTS United States California, South Carolina Reduce alcohol • DUI enforcement injury and death • Alcohol service • News coverage • Underage sales • Alcohol outlets Minnesota Reduce youth drinking Massachusetts Reduce alcohol crashes 10% reduction in alcohol crashes 43% reduction in violence Lower alcohol sales to youth • Local sales policies Lower alcohol and enforcement sales to youth Reduced traffic crashes • News coverage 25% reduction in • DUI enforcement fatal crashes • Alcohol outlet surveillance

Examples of International Community Action Projects for Alcohol Prevention COUNTRY GOALS STRATEGIES Sweden STAD Project Stockholm RESULTS Reduction in sales Reduced local alcohol and drug problems • Responsible Beverage Service • Joint parent/police enforcement of sales to youth • Club policy and drug recognition by door security Lower alcoholinvolved violence • Community forum Reduction in and alcohol safety violent events: audit original site from • Model house policies 9. 8 to 4. 7 and • Increased enforcereplication sites ment of alcoholfrom 12. 2 to 3. 0 licensed premises to intoxicated patrons (47% to 5%) Violent crime down by 29% Refusals of drug impaired patrons increased by 300% Australia Surfers Paradise Safety Action Project

What Have We Learned to This Point? Environmental prevention can produce measurable results. Logic Model in environmental prevention must be based on empirical evidence about intermediate variables. Environmental strategies must be selected that have been shown to work—that is, impact key intermediate variables. Do few things well. High “dosage” to be effective.

Next n Learn tools and approaches to monitor and evaluate environmental strategies. n Discuss ways for communities in more effective in environmental prevention.